Deconjugation of soy isoflavone glucuronides needed for estrogenic activity

Soy isoflavones (SIF) are present in the systemic circulation as conjugated forms of which the estrogenic potency is not yet clear. The present study provides evidence that the major SIF glucuronide metabolites in blood, genistein-7-O-glucuronide (GG) and daidzein-7-O-glucuronide (DG), only become estrogenic after deconjugation. The estrogenic potencies of genistein (Ge), daidzein (Da), GG and DG were determined using stably transfected U2OS-ERα, U2OS-ERβ reporter gene cells and proliferation was tested in T47D-ERβ cells mimicking the ERα/ERβ ratio of healthy breast cells and inT47D breast cancer cells. In all assays applied, the estrogenic potency of the aglycones was significantly higher than that of their corresponding glucuronides. UPLC analysis revealed that in U2OS and T47D cells, 0.2-1.6% of the glucuronides were deconjugated to their corresponding aglycones. The resulting aglycone concentrations can account for the estrogenicity observed upon glucuronide exposure. Interestingly, under similar experimental conditions, rat breast tissue S9 fraction was about 30 times more potent in deconjugating these glucuronides than human breast tissue S9 fraction. Our study confirms that SIF glucuronides are not estrogenic as such, and that the small % of deconjugation in the cell is enough to explain the slight bioactivity observed for the SIF-glucuronides. Species differences in deconjugation capacity should be taken into account when basing risk-benefit assessment of these SIF for the human population on animal data.

Gallstone among Patients Presenting to the Department of Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study

INTRODUCTION

Gallstone is the most common biliary pathology. Once thought of as a disease of the western world, the incidence and burden of cholelithiasis are increasing in Asia. Its literature from Nepal is however still primitive. The study aimed to find out the prevalence of gallstone among patients presenting to the Department of Surgery in a tertiary care centre.

METHODS

A descriptive cross-sectional study was conducted among patients presenting to the Department of Surgery after receiving ethical approval from the Institutional Review Committee (Registration number: 625). The study was conducted from 1 June 2022 to 1 November 2022. Patients with age more than 18 years were included and patients less than 18 years of age, having common bile duct stones, suffering from biliary malignancy or having an immunocompromised state were excluded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated.

RESULTS

Among 1700 patients, gallstone was seen in 200 (11.76%) (10.23-13.29, 95% Confidence Interval). Among the 200 patients, 133 of them (66.50%) were females. Multiple gallstones were present in 118 (59%) cases whereas 82 (41%) cases had a single stone.

CONCLUSIONS

The prevalence of gallstone was found to be similar as compared to other reported literature.

KEYWORDS

cholelithiasis; gallbladder; prevalence.

Spontaneous splenic hematoma secondary to dengue infection: a rare case report

Dengue infection may have various surgical complications. Splenic hematoma is a rare complication of dengue hemorrhagic fever and may be life-threatening.

Case Presentation

A 54-year-old male, diagnosed with dengue infection detected at another hospital, presented on the 10th day of fever with left upper abdominal pain for 7 days without history of trauma. Urgent ultrasonography of the abdomen revealed findings suggestive of a splenic subcapsular hematoma, which was confirmed by computed tomography scan. The grade II splenic hematoma was being managed conservatively. Unfortunately, the patient developed hospital acquired pneumonia and died from septic shock.

Clinical Discussion

Hemorrhagic manifestations are seen in the febrile and critical phase of dengue, but the spleen is infrequently involved. Splenic hematoma can lead to splenic rupture, which can be rapidly fatal. Specific treatment guidelines of such hematomas are needed in the context of dengue infection, as the treatment modality is controversial.

Conclusion

Patients must be carefully evaluated for the complications and surgical manifestations of dengue as abdominal pain and hypotension from splenic hematoma may be misinterpreted as components of dengue hemorrhagic fever and dengue shock syndrome.

Functional Outcome of Solid Interlocking Nail in Open Tibial Fracture at a Tertiary Care Center: A Descriptive Cross-sectional Study

INTRODUCTION

There is a high incidence of open fractures accounting 23% of all tibial fractures. The minimal soft tissue and precarious blood supply of the shaft of tibia make these fractures vulnerable to complications. The treatment should be decided through thoughtful analysis for personality of injuries and the status of the soft tissue. Intramedullary nailing allows stable fixation with minimal soft tissues dissection and preserve the soft tissue and allows early joint motion with higher rate of union. The purpose of our study was to find the outcome of open tibial fractures lower than Gustilo type IIIb, that were treated by unreamed solid interlocking intramedullary nails.

METHODS

A descriptive cross-ectional study was conducted from December 2021 to June 2023 after taking approval from ethical committee. All 34 patients treated with solid interlocking intramedullary nail, without reaming for open tibial fracture during 18 months period were included in the study. Final follow up was done at one year and the outcome was assessed by Modified Ketenjian's criteria.

RESULTS

The mean time of union rate was 15.82±3.95 weeks. Complications were: superficial infections in 4 (11.76%) patients and deep infection in 1 (2.94%) patient. Using Modified Ketenjian's Criteria, 26 (76.47%) patients had an excellent result followed by good in 7 (20.59%), fair in 1 (2.94%) and there was no case with  poor outcome.

CONCLUSIONS

Solid intramedullary interlocking nail is an effective treatment with minimal soft tissue dissection for open tibia fracture less than GA III B as it provides stable fixation with early mobilization and provides a high rate of union, less complication and early return to function.

Patient Safety and organizational Safety Culture in Surgery: A Need of an Hour in the developing countries

Every year, more than 200 million surgeries are performed around the world, and recent statistics show that adverse event rates for surgical pathologies remain unacceptably high, despite several national and global patient safety initiatives over the last decade. Patient safety is diverse and highly complicated in nature, with several critical components. Although concern for patient safety is fundamental in health care practice, its transition into knowledge is comparatively recent, and hence patient safety may be deemed a "new" field. Current surgical safety guidelines and checklists are generic and not adapted to specific patient concerns and risk factors in surgical subspecialties. All surgical practitioners and health care organizations must therefore become better aware of the fundamental context of patient safety, actively participate in endeavors to integrate patient safety measures in daily practice, and foster a patient safety culture. The purpose of this review article is to outline patient safety in surgical techniques that should be adopted and implemented.

Acute Pancreatitis among Patients Visiting the Department of Surgery in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Acute pancreatitis is the inflammation of pancreatic parenchyma characterised by severe abdominal pain and nausea. It is a common gastrointestinal disease requiring hospital admission. The death rate for mild acute pancreatitis is low but severe acute pancreatitis can reach up to 40%. This study aimed to find the prevalence of acute pancreatitis among patients attending the Department of Surgery in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from 1 October 2021 to 30 March 2022. The study was conducted after receiving ethical approval from the Institutional Review Committee (Registration number: 454). Patients with age more than 18 years were included and patients less than 18 years of age including those suffering from chronic pancreatitis, pancreatic malignancy or immunocompromised states were excluded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1560 patients, the prevalence of acute pancreatitis in our study is 120 (7.69%) (2.92-12.46, 95% Confidence Interval). Out of them, 57 (47.50%) were males and 63 (52.50%) were females. Out of total, hypertension found in 52 (43.33%) was the most common co-morbidity observed followed by diabetes mellitus 18 (15%). Similarly, 80 (66.67%) patients had mild pancreatitis whereas 40 (33.33%) had moderate pancreatitis and 8 (6.67%) had severe pancreatitis. Conclusions: The prevalence of acute pancreatitis among hospital admissions in the department of surgery in a tertiary care centre was found to be similar to other studies done in a similar setting.